Mr. Ejaz Khan is an Exovent team member and Trustee who hails originally from Pakistan, but lives here in the UK and has a truly global reach. He is the CTO of the Right Metrics LLC of New York, USA and has over 25 years experience as a senior consultant in Information Technology. He has provided services in the financial industry to over 30 countries including large organisations which are household names in banking and finance. In September 2021 Ejaz set out to contact senior medics and engineers in Pakistan in the hope that they would join our international pioneer groups to build and develop a negative pressure Exovent respiratory support device.
With help from his contact, Mr Ahsan Khan, they quickly set up Zoom meetings with Dr Zainab Samad, Consultant Cardiologist and Professor and Chair of the Department of Medicine in the world-famous Aga Khan Hospital and University in Karachi. She then brought into these meetings her consultant colleagues from Respiratory Medicine and Critical (Intensive) Care. In addition Ejaz and Ahsan established contact with Mr A.R Allana, Chairman, Alsons Group, and his team in Karachi. Alsons Group is one of Pakistan’s largest and most vertically integrated groups of engineering concerns with over 70 years of innovative manufacturing experience in the Automotive, Aerospace, Defence, Power & Energy, Oil & Gas, Lighting and Medical Device industries. They have been exporting worldwide since 1992.
The initial Zoom meetings involved multiple members of the UK Exovent team with the doctors from Aga Khan hospital and the team of expert engineers from Alsons. We were delighted when they rapidly agreed to work together and the Alsons team produced their own version of Exovent in an astonishingly short time of just a few days. The quality and innovations they introduced in the cabinet design and controller were nothing short of astonishing, and demonstrate once again that there are many countries around the world who have the expertise to rapidly produce this effective, low cost, respiratory support device. An important point that we have made from the outset of our project is the construction of an Exovent device does not use materials that are needed for the current range of CPAP and positive pressure ventilation devices. Indeed Alsons were producing the Alnno-Ventura HFNO/CPAP device from the design and specifications of University College London; Ventura is a UK certified , sophisticated device, designed during the Covid pandemic. They were also producing the AlnnoVent AVB-100 electromechanical positive pressure ventilator at the same time!
During the first half of 2022 our major discussions with the Aga Khan team involved the difficulties and financing of future clinical trials, just the same challenge that we face in the UK, once all the technical and medical files have passed the regulators. At the same time the engineers of Alsons were exploring the difficulties of finding the best type of neck and hip seal for the cabinet. In June of 2022 I decided to go to Pakistan myself to assist with discussions on behalf of the UK Exovent team. I arrived in Karachi on the 1st of August to find the temperature there was several degrees cooler than in London, a surprise that I had not expected having travelled many times to nearby northern India over many years! Our UK 2022 summer was the hottest on record.
The following day of the 2nd of August was certainly busy. In the morning I attended the Jinna Sindh University postgraduate medical education centre where they had organised a workshop in collaboration with the Alsons group, to highlight recent advances and techniques in the field of medicine. I gave a lecture outlining some of the important innovations in healthcare over the last hundred years. I began by reminding my friends in Pakistan of the incredible Indus Valley civilisation, which lasted 2000 years from approximately 3300 BC to 1300 BC. It was a civilisation within the area of modern day Pakistan with many health advantages, derived from technology invented before the greatest Chinese and European civilisations. Their highly efficient water supply, waste collection and drainage were unmatched until those of the much acclaimed Romans 1000 years later.
Moving on into the 20th century I discussed the discovery of penicillin and the fact that it took more than a decade to manufacture it in useful quantities. I reminded them of the two decades that it required to introduce the laryngeal mask into modern day anaesthesia and lasers into modern surgery. Medical innovations take time, persistence and finance to introduce, even if they are a brilliant idea!
The afternoon involved a fascinating visit to the Alsons group factories and it was truly inspiring to see the high-quality precision engineering of so many different products. We read so much about the difficulties of Pakistan, notably recently, of course, it’s devastating floods and the effect on its huge population. However, the sophisticated engineering and the tremendous efforts of the highly educated and skilled members of the factory team demonstrate the huge potential that lies within Pakistan, to overcome their difficulties and forge forwards in the modern world. This was followed by a quick departure to the airport to catch a plane to Islamabad, the capital of Pakistan.
The following full day was a conference organised by Systems Ltd and the Pakistan Engineering Council and the Alsons group. There were multiple guest speakers from industry and academia who shared their own journeys in the world of healthcare innovation, once again clearly demonstrating the potential that lies within Pakistan. I was honoured to present my own views and join the discussion. Mr Allana, chairman of the Alsons group, spoke eloquently about his feelings for the way forward. Dr Samreen Hussain, convener of the Innovation and Entrepreneurship committee of the Pakistani Engineering Council and Supervisor and Vice Chancellor of Naira PaliJo’s laboratory at Aror University gave a fascinating speech. Her talk blended healthcare from an academic perspective and practical solutions from industry experts.
After flying back to Karachi in the evening I went the following day to the remarkable Indus hospital to lecture and discuss about reintroducing negative pressure respiratory support and present the Exovent. Spread over 20 acres of land, and located in the densely populated Korangi area, The Indus Hospital is a 300-bed tertiary care multidisciplinary hospital providing premium healthcare in an impressive, state-of-the-art facility completely free to everyone.
It is Pakistan’s first paperless hospital and has now become a symbol of hope for the most vulnerable members of society.
I met the remarkable founder of The Indus Hospital, Dr. Abdul Bari Khan, who, with his co-founders, had served in the public sector hospitals for many years. During their time at government-run hospitals, they witnessed the plight of the poverty-stricken patients of Karachi. They envisioned making a multidisciplinary tertiary care hospital for the under-served population of Karachi with free quality treatment.
In 2005, the Islamic Mission Trust donated a non-functioning hospital building to its founders. This building was renovated and made operational in the year 2007. The Indus Hospital was set up as a tertiary care and multidisciplinary hospital with 150 beds. It serves as an absolutely free of charge hospital.
They have achieved their initial aims and now the Indus Hospital has evolved into a Health Network with hospitals and public health outreach clinics spread all across Pakistan. The whole of this network could use very many Exovent devices, as is the case in so many LMIC countries.
This sobering visit was followed by an enjoyable afternoon with Mr. Akbar Allana in the Alsons factory headquarters with a joint Zoom meeting between the Alsons engineers and some of the Exovent team in the UK to discuss the situation with regard to control units and seals. I slept very well on the overnight flight back to the UK!
We look forward to continuing our association with Alsons.
Prof. David Howard.